Corticosteroids as Additive in Temporomandibular Joint (TMJ) Arthrocentesis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01275014
Recruitment Status : Unknown
Verified November 2010 by University Medical Center Groningen.
Recruitment status was:  Active, not recruiting
First Posted : January 12, 2011
Last Update Posted : January 12, 2011
Information provided by:
University Medical Center Groningen

Brief Summary:
The aim is to compare the effectiveness of corticosteroid administration (dexamethasone) with a placebo (saline), following arthrocentesis of for the temporomandibular joint (TMJ). Twenty-eight participants with TMJ arthralgia, mainly related to osteoarthritis ae randomly assigned to two arms of a parallel double blind RCT. In both arms an arthrocentesis procedure is carried out, while a single dose intraarticular dexamethasone was delivered to participants in one arm. Saline was delivered in the other arm to serve as a control. Follow up visits were scheduled after 1, 3 and 24 weeks. During each visit TMJ pain (on a 100mm VAS) and joint stiffness (mouth opening in mm) are scored. Generalized estimating equations (GEE) are used for statistical analysis.

Condition or disease Intervention/treatment Phase
Arthritis Drug: Dexamethasone Drug: Isotonic saline Phase 4

Detailed Description:

The arthrocentesis procedure was performed under local anaesthesia and took place in a closed operation room under controlled conditions. After marking the points for insertion of the needles, a first 18 gauge injection needle was inserted into the upper intra-articular space of the TMJ. Correct positioning of the needle was determined by injecting and aspirating saline. Subsequently, a second 18 gauge needle was inserted into the upper joint space about 8-10 mm anterior of the first needle. Correct positioning of the second needle was confirmed by allowing injected saline to leave the joint through the first needle. After positioning of the needles, one needle was connected to a medical infusion system to passively allow isotonic saline of 37 degrees Celsius to enter the upper joint compartment. The other needle was connected to an outflow tube to allow the fluid to exit the joint. In about 15 minutes, approximately 300 ml saline passively flushed the joint. Thereafter, the inflow was stopped and the prepared syringe (see randomisation procedure) that contained either dexamethasone or saline was connected to the inflow needle. In this way, either 1 cc of dexamethasone or an equal amount of saline was washed through the joint in a blinded way. At the end of the procedure, the needles were removed from the joint, and after hemostasis by compression (if necessary) the skin overlying the TMJ was covered with a sterile band aid.

All patients were then instructed to avoid TMJ loading by following a soft diet for at least two weeks, then gradually advancing to more tough food. In addition, ibuprofen 600 mg 3dd was prescribed for the first 2-5 days to reduce any postoperative pain. All procedures were performed by one surgeon.

Follow up visits were scheduled after 1 (T1), 3 (T2) and 24 (T3) weeks.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Corticosteroids as Additive in Arthrocentesis of the Temporomandibular Joint: Double Blind, Randomised Controlled Trial of Effectiveness.
Study Start Date : December 2008
Estimated Primary Completion Date : December 2010
Estimated Study Completion Date : December 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Steroids
U.S. FDA Resources

Arm Intervention/treatment
Placebo Comparator: Placebo Drug: Isotonic saline
1 ml of isotonic saline was applied once, following the arthrocentesis procedure of the TMJ
Experimental: Dexamethasone Drug: Dexamethasone
1 ml of 20mg/ml solution was applied once, following the arthrocentesis procedure of the TMJ

Primary Outcome Measures :
  1. Change from Baseline in TMJ pain at 24 weeks [ Time Frame: 0 (T0), and at 1 (T1), 3 (T2) and 24 (T3) weeks. ]
    Change over 24 weeks from baseline for TMJ pain at rest and during mandibular movements. Measured by a 100 mm Visual Analogue Scale (VAS), limited by "no pain" and "worst pain imaginable".

  2. Change from Baseline in Maximal interincisal opening at 24 weeks [ Time Frame: T0, and at T1, T2 and T3. ]
    Change over 24 weeks from baseline maximal interincisal opening at rest and during mandibular movements . Measured in mm between the incisal edges of the center incisors.

Secondary Outcome Measures :
  1. Change from baseline of mandibular function impairment at 24 weeks. [ Time Frame: T0, T1, T2 and T3 ]
    Change over 24 weeks from baseline for the MFIQ. The MFIQ is a questionnaire assessing, on a five point scale, discomfort while performing mandibular functions and during eating of food with different consistencies (range of 0 - 68).

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Pain localized in one of the TMJs (TMJ arthralgia).

Exclusion Criteria:

  • No significant relief of pain within 10 minutes after anaesthesia (injecting 0,1 ml articaine 40 mg/ml) of the TMJ
  • Past history of open surgery in the affected joint
  • Known polyarthritis (mostly rheumatoid arthritis)
  • Age under 18 yrs
  • Ankylosis of the TMJ
  • Reported pregnancy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01275014

University Medical Centre Groningen
Groningen, Netherlands, 9700 RB
Sponsors and Collaborators
University Medical Center Groningen
Principal Investigator: James Huddleston Slater, PhD University Medical Center

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: JJR Huddleston Slater, University Medical Center Groningen Identifier: NCT01275014     History of Changes
Other Study ID Numbers: UMCG_KCHIR_01
14439 ( Other Identifier: Medical Ethical Committee University Medical Center )
First Posted: January 12, 2011    Key Record Dates
Last Update Posted: January 12, 2011
Last Verified: November 2010

Keywords provided by University Medical Center Groningen:

Additional relevant MeSH terms:
Dexamethasone acetate
BB 1101
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action